Term Ventilation The Japanese Perspective

National Yakumo Hospital, Yakumo, Hokkaido, Japan 

Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan 

History of Long-Term Ventilation and Home Mechanical Ventilation 

In contrast to some countries, the polio epidemics of the 1950s did not trigger the initiation of long-term ventilation (LTV) in Japan (1). The first patient to receive LTV at home was in Tokyo in 1975, when an adult with neuromuscular disease (NMD) received tracheal invasive positive pressure ventilation (TIPPV) (2). Despite the introduction of public assistance for costs associated with home mechanical ventilation (HMV), fewer than 200 patients were receiving HMV between 1990 and 1993 (Fig. 1) (2). 

By 1994, fees paid by medical insurance increased to cover medical services provided by the hospital, clinic, or home care nurse as well as the costs of medical equipment, such as the ventilator rental. This led to rapid growth in the population of patients receiving HMV (2). In April 1995, of the 536 HMV cases 65% had NMD, 20% had parenchymal disease (PD), such as sequelae of tuberculosis and chronic obstructive pulmonary disease (COPD), and 15% had thoracic restriction or central hypoventilation syndrome (3,4). In June 1995, of the 1006 patients undergoing LTV for at least three months, 215 (21%) could have been discharged to a home care setting if an appropriate public assistance program had been established (3,4). By January 1997, there were 1250 patients receiving HMV of whom 461 (1.2 people/million) used noninvasive positive pressure ventilation (NIPPV) (5). 

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